VACCINATIONS

CONDITIONS AND MANAGEMENT

BY

DR. MO SOBHY

1
 INDEX

1. MMR Vaccine…………………………….….……..……..………..……….3
2. Flu vaccine.……….……...…..…………………..………..…...................8
3. Chicken pox in pregnancy...………………..……….……..………12
4. Meningitis Vaccine.………..……….............................……...……18
5. 8 week Vaccine……………….………………..….……………………..21

2
 MMR vaccine

- Station
You are F2 in GP. 12 months old child is due to be given her MMR
vaccine in the next two weeks. Mrs. Emiley Harriet, Sophia’s mother,
presented to the GP surgery to discuss about her daughters MMR
vaccination. You haven’t seen Jenny since birth. Please talk to the mother
and address her concerns. It is a non-emergency visit.

Information about MMR vaccine

- The MMR vaccine is a safe and effective combined vaccine. It

protects against 3 serious illnesses : measles - mumps - rubella
(german measles)
 These highly infectious conditions can easily spread between
unvaccinated people.
 Getting vaccinated is important, as these conditions can also lead to
serious problems including meningitis, hearing loss and problems
during pregnancy.
 2 doses of the MMR vaccine provide the best protection against
measles, mumps and rubella.

- When children should have the MMR vaccine

 The MMR vaccine is given to babies and young children as part of
the NHS vaccination schedule.
 MMR vaccine schedule :
 1 year → MMR (1st dose)
 3 years and 4 months → MMR (2nd dose)

3
 You can still contact us for the MMR vaccine if your child has missed
either of these 2 doses.

- When older children and adults should have the MMR vaccine
 Anyone who has not had 2 doses of the MMR vaccine should ask their
GP surgery for a vaccination appointment.
 It's important to check you've had both doses if you:
 are about to start college or university
 are going to travel abroad
 are planning a pregnancy
 are a frontline health or social care worker
 were born between 1970 and 1979, as you may have only been
vaccinated against measles
 were born between 1980 and 1990, as you may not be
protected against mumps

- How the MMR vaccine is given

 The MMR vaccine is given as 2 doses of a single injection into the
muscle of the thigh or upper arm.
 2 doses of the vaccine are needed to ensure full protection.

- Effectiveness of the MMR vaccine

 The MMR vaccine is very effective.
 After 2 doses:
 around 99% of people will be protected against measles and
rubella
 around 88% of people will be protected against mumps
People who are vaccinated against mumps, but still catch it, are less
likely to have serious complications or be admitted to hospital.

4
 Protection against measles, mumps and rubella starts to develop
around 2 weeks after having the MMR vaccine.

- Side effects of the MMR vaccine

 The MMR vaccine is very safe. Most side effects are mild and do not
last long, such as:
 the area where the needle goes in looking red, swollen and
feeling sore for 2 to 3 days
 around 7 to 11 days after the injection, babies or young children
may feel a bit unwell or develop a high temperature for about
2 or 3 days
 Some children might also cry and be upset immediately after
the injection. This is normal and they should feel better after a
cuddle. .However, the possible complications of infectious
conditions, such as measles, mumps and rubella, are much more
serious.

- Common side effects of the MMR vaccine

 As there are 3 separate vaccines within a single injection, different side
effects can happen at different times.
 Measles vaccine side effects

Around 7 to 11 days after the injection, some children get a

very mild form of measles. This includes : a rash - a high
temperature - loss of appetite - a general feeling of being
unwell for about 2 or 3 days
These symptoms are not infectious, so your child will not
pass anything on to non-vaccinated children.

 Mumps vaccine side effects

5
 Around 3 to 4 weeks after the injection, 1 in 50 children develop a
mild form of mumps. This includes swollen glands in the cheeks,
neck or under the jaw which can last for up to 2 days.
These symptoms are not infectious for other people.

 Rubella vaccine side effects

Around 1 to 3 weeks after the injection, some adult women

experience painful, stiff or swollen joints for up to 3 days.

 Rare side effects of the MMR vaccine

 Bruise-like spots : This side effect is linked to the rubella
vaccine and is known as idiopathic thrombocytopenic purpura
(ITP).
 Seizures (fits) : This can be caused by having a high
temperature in response to the measles vaccine virus.

- Allergic reactions to the MMR vaccine

 It's rare for anyone to have a serious allergic reaction to a vaccine. If
this does happen, it’s usually within minutes.
 The person who vaccinates you or your child will be trained to deal
with allergic reactions and treat them immediately. With fast
treatment, you or your child will make a good recovery.
 Let us know if you or your child has had severe allergic reactions to:
 Gelatin
 an antibiotic called neomycin
 Egg allergies
 The MMR vaccine is safe for children and adults with a severe
egg allergy.
 This is because the MMR vaccine is grown on chick cells, not the
egg white or yolk.

6
- The MMR vaccine is not linked to autism
 There's no evidence of any link between the MMR vaccine and autism.
There are many studies that have investigated this.
 There are now a large number of studies that show no evidence at all
of any link between the MMR vaccine and autism. Autism is a
developmental disorder which is usually diagnosed in pre-school
children. The original research which suggested a link has now been
discredited.
 The National Autistic Society in the UK has issued a statement saying
that ‘there is no link between autism and the MMR vaccine’.

7
 Flu vaccination

- Station
You are F2 in GP. Mrs Julia Smith , wants to talk to you about her son ,
Adam 3 years old , who is due to a flu vaccine in 1week time. Talk to her
and address her concerns.

Information about flu vaccine

 The children's flu vaccine is safe and effective. It's offered every year
as a nasal spray to children to help protect them against flu.
 Flu is caused by a virus. It can be a very unpleasant illness for
children. It can also lead to serious problems, such as bronchitis and
pneumonia.
 Children spread flu easily. Vaccinating them also protects others
who are vulnerable to flu, such as babies and older people.

- Who should have the nasal spray flu vaccine

 The nasal spray flu vaccine is free on the NHS for children aged 2 to
17 years with or without long-term health conditions

- Some children will have the injected flu vaccine if they have:
 The injected flu vaccine is given as a single injection into the muscle
of the upper arm.
 Children aged 2 to 17 years may also have the flu vaccine
injection if the nasal spray vaccine is not suitable for them.
 a weakened immune system
 had a severe allergic reaction (anaphylaxis) to egg in the past

8
  asthma that's being treated with steroid tablets or that needs
treatment in hospital
 been wheezy in the past 72 hours or are currently wheezy
 had an allergic reaction to a flu vaccine in the past
 a condition that needs salicylate treatment
 If your child is aged between 6 months and 2 years and is in a
high-risk group for flu, they'll be offered a flu vaccine injection
instead of the nasal spray.This is because the nasal spray is not
licensed for children under 2 years.

- Children with long-term health conditions, such as diabetes or

heart problems, or on steroids or chemotherapy are at higher risk
from flu.It's important they're vaccinated.

- Contraindications :
 if the child is unwell on the day, Your child should wait until they're
better before having the nasal spray flu vaccine if they have:
 a very blocked or runny nose – these might stop the vaccine
getting into their system
 a high temperature

- How the nasal spray flu vaccine is given

 The vaccine is given as a spray squirted up each nostril. It's quick
and painless.
 The vaccine will still work even if your child gets a runny nose,
sneezes or blows their nose.
 If your child is under 9 years old and has never had a flu vaccine
before, they’ll be given 2 doses. These doses are given 4 weeks apart.

9
- How effective is the nasal spray flu vaccine?
 The nasal spray flu vaccine gives children the best protection against
flu.
 It may take around 2 weeks for the flu vaccine to work
 Any children who catch flu after vaccination are less likely to be
seriously ill or be admitted to hospital.

- Side effects of the children's flu vaccine

 The nasal spray flu vaccine for children is very safe. Most side effects
are mild and do not last long, such as:
 a runny or blocked nose
 a headache
 tiredness
 loss of appetite

 If your child has the injected flu vaccine, side effects include:
 a sore arm where the injection was given
 a slightly raised temperature
 aching muscles
 These side effects usually last for a day or 2.

- What's in the nasal spray flu vaccine?

 The nasal spray flu vaccine contains small amounts of weakened flu
viruses. They do not cause flu in children.
 As the main flu viruses can change each year, a new nasal spray
vaccine has to be given each year.
 The brand of nasal spray flu vaccine available in the UK is called
Fluenz Tetra.
 The nasal spray vaccine contains pork gelatine. If this is not suitable,
speak to us about your options.

10
- Flu vaccine and coronavirus (COVID-19)
 Flu vaccination is important because:
 if you're at higher risk from coronavirus, you're also more at
risk of problems from flu
 if you get flu and coronavirus at the same time, research
shows you're more likely to be seriously ill
 it'll help to reduce pressure on the NHS and social care staff
who may be dealing with coronavirus
 If you've had COVID-19, it's safe to have the flu vaccine. It'll be
effective at helping to prevent flu.

11
 Chicken pox in pregnancy

- Station
You are an FY2 in GP. Clare Josh aged 35 years come to you with some
concerns. Talk to her and address her concerns.

- What does 'contact with chickenpox mean?

 A person with chickenpox is very infectious. The virus spreads in the
air from person to person. For example, if you have not already had
chickenpox, you stand a good chance of catching it if:
 You are in the same room as someone with chickenpox for
more than 15 minutes; or
 You have any face-to-face contact with someone with
chickenpox, such as having a conversation.
 Chickenpox is infectious from two days before the spots first appear
until they have all crusted over. This is commonly about five days
after the spots appear. So, for example, if you talked to someone
yesterday who developed the chickenpox rash today, you are at risk of
developing chickenpox if you are not immune.

- If you have been in contact with chickenpox :

 If you have had chickenpox in the past, you are likely to be immune.
You are less likely to be at risk. You do not need to worry or do
anything, but may want to discuss this with your doctor or midwife.
 If you have not had chickenpox, or are not sure, see a doctor
urgently. A blood test may be advised to detect antibodies to see if
you are immune.

12
- What is the blood test?
 The blood test checks for antibodies to the chickenpox virus:
 If you have antibodies in your blood, this means you have had
chickenpox in the past, or have been immunised. No further
action is then needed.
 If you do not have any antibodies then you are at risk of
developing chickenpox.

- What can I do if I have no antibodies?

 You can be given an injection called immunoglobulin which contains
antibodies to the chickenpox virus.
 This may prevent chickenpox from developing, or make it a much
less serious infection if it does develop.
 It is best to have the immunoglobulin injection within four days of
coming into contact with the virus.
 However, there may be some protection even if you are given
immunoglobulin up to 10 days after contact with the virus. (It takes
between 7 and 21 days (most commonly 10-14 days) for the
chickenpox illness to develop after coming in contact with an infected
person. This is the incubation period.)

- Why is it important to avoid chickenpox during pregnancy?

 For the mother
 Chickenpox is typically an unpleasant illness when you are
pregnant, even without complications. It tends to be much
more severe than the illness children get.
 In addition, about 1 in 10 pregnant women with chickenpox
develop inflamed lungs (pneumonia). This is sometimes
serious. About 1 in 100 pregnant women who develop
chickenpox-related pneumonia die of this serious infection.

13
  Brain inflammation (encephalitis) and ataxia (problems
with co-ordination of movements) are uncommon but very
serious complications.
 Vary rarely, other serious complications develop. For
example: inflammation of the heart muscle
(myocarditis), inflammation of the kidneys
(glomerulonephritis), appendicitis, inflammation of the
pancreas (pancreatitis), inflammation of the joints (arthritis),
and inflammation of various parts of the eye.
 For the unborn baby
 There is a small chance of the baby developing a condition
called fetal varicella syndrome (FVS). This can cause the baby
to be born with serious abnormalities. These include:

Scarring of the skin.

Problems with the eyes.
Arms and legs which haven't grown normally.
Problems with brain development.

 FVS is very rare. The chances of your baby getting it if you

had chickenpox in pregnancy are as follows:

If you have chickenpox within the first 12 weeks of

pregnancy there is about a 1 in 200 chance of the baby
developing FVS.
If you have chickenpox between 13 and 20 weeks of
pregnancy there is about a 1 in 50 chance of the baby
developing FVS.
If you have chickenpox after 20 weeks, the risk of the
baby developing FVS is very low, with no reported cases

14
 in women who developed chickenpox after 28 weeks of
pregnancy.
If you have chickenpox within seven days before or
after giving birth, your newborn baby may develop a
severe form of chickenpox. Some newborn babies who
develop chickenpox die from the infection. This is the
most dangerous time for babies, but there is an
immunisation to help stop this happening.
If a pregnant woman develops chickenpox, it is possible
for the baby inside her womb to catch it before they are
born. Babies who had chickenpox in this way can develop
shingles at some point in their lives. This is a reactivation
of the virus they caught whilst in their mother's womb.

- What if I develop chickenpox when I am pregnant?

 Most pregnant women who have chickenpox recover fully and their
babies are fine. However, as discussed above, the illness tends to be
unpleasant and there is some risk of complications. In short:
 See a doctor urgently if you suspect that you have chickenpox
when you are pregnant, or within seven days of giving birth.
 If you do develop chickenpox, you (and your baby if newborn)
should be reviewed daily. You may need a hospital
assessment if you have lung disease, are a smoker, or are
taking treatment which affects your immune system (such as
steroids). If you have any of the following, see a doctor
immediately, as you may need treatment in hospital:

Severe spots (a severe rash).

A bleeding rash.
Chest/breathing problems.
Drowsiness.

15
 Being sick (vomiting).
Bleeding from your vagina.

 Antiviral medication, such as aciclovir, is an option to treat

chickenpox.

 To be of benefit, it must be started within 24 hours of the rash

first appearing.
 It does not cure the illness but tends to make it less severe.
 It may help to prevent complications developing in mother
and baby (described above). This would be advised by a
specialist in hospital.
 You are likely to be referred for a detailed ultrasound scan at 16-
20 weeks of the pregnancy, or five weeks after the infection has
cleared if the infection was later on in the pregnancy. The aim of
this is to look for signs of fetal varicella syndrome (FVS).

 If you develop chickenpox within seven days before or after the

birth of your baby

 the baby can be given immunoglobulin treatment (described

above). This aims to prevent chickenpox developing in the baby.
 Newborn babies who do develop chickenpox despite this may be
treated with antiviral medicines by specialists in hospital.
 Avoid other pregnant women and newborn babies until all
the spots have crusted over (commonly about 5-6 days after
onset of the rash).

- Can I be immunised against chickenpox?

 There is an effective vaccine that protects against the virus that
causes chickenpox.

16
 If you are not sure if you have had chickenpox, a blood test can
check if you have previously had it. (About 1 adult in 10 has not had
chickenpox as a child.)

 The Royal College of Obstetricians and Gynaecologists also

recommends that immunisation against chickenpox should be
considered by all non-immune women before they become
pregnant, or soon after they give birth.

17
 Meningitis prophylaxis

- Station
You are an FY2 doctor in GP surgery. Micheall Riley aged 53 ,
presented with a concerns. Talk to her and address her concerns.

- Preventing the spread of infection

 The risk of someone with meningitis spreading the infection to
others is generally low.

 But if someone is thought to be at high risk of infection, they may be

given a dose of antibiotics as a precautionary measure.

 This may include anyone who's been in prolonged close contact

with someone who developed meningitis, such as:

 people living in the same house

 pupils sharing a dormitory
 university students sharing a hall of residence
 a boyfriend or girlfriend
 People who have only had brief contact with someone who
developed meningitis will not usually need to take antibiotics.

- Prophylaxis for contacts

 The decision to initiate contact tracing in respect of meningococcal
infection will be made by the Consultant in Public Health
Medicine (CPHM) in conjunction with relevant clinicians.

18
  Responsibility for contact tracing and organising the administration
of chemoprophylaxis also lies with the CPHM.

 Chemoprophylaxis must ONLY be prescribed on the instruction

of the CPHM. It should be given as soon as possible (ideally within
24 hours) after diagnosis of the index case.

- CPHM will establish a list of close contacts; who may include

 Those who have had prolonged close contact with the case in a
household type setting during the seven days before onset of
illness.

 Examples of such contacts would be those living and / or sleeping

in the same household (including extended household), pupils in
the same dormitory, boy/girlfriends, or university students
sharing a kitchen in a hall of residence.

 Those who have had transient close contact with a case only if
they have been directly exposed to large particle droplets /
secretions from the respiratory tract of a case around the time
of admission to hospital.

- Recommended chemoprophylaxis
 Ciprofloxacin

 Adults and children aged 12 years and over (500 mg orally as

a single dose )
 Children aged 5-11 years (250 mg orally as a single dose )
 Full term neonates – 4 years ( 30mg/kg orally as a single dose
up to a maximum of 125mg. )

19
  The use of single dose ciprofloxacin is recommended by a Cochrane
Reviewii and included in the Public Health England’s Guidance for
public health management of meningococcal disease in the UK’.
Ciprofloxacin is licensed in adults for the prophylaxis of invasive
infections due to Neisseria meningitidis; however its use in
children and adolescents remains ‘off label.’

 If further cases occur within a group of close contacts in the four

weeks after receiving prophylaxis, an alternative agent should be
used for repeat prophylaxis.

 Rifampicin may be used (except in pregnancy). Azithromycin as a

single dose of 500mg may be used as an alternative in pregnancy.

- Alternative chemoprophylaxis regime

 Rifampicin

 Adults and children aged 12 years and over ( 600 mg bd for 2

days )
 Children aged 1-11 years ( 10 mg/kg bd for 2 days (maximum
dose 600mg )
 Infants (under 12 months) 5mg/kg bd for 2 days )

- MENINGOCOCCAL INFECTION CHEMOPROPHYLAXIS

 When the serotype is known, Public Health may offer vaccines to
relevant close contacts.

 Vaccination should not delay antibiotic chemoprophylaxis..

20
 8 week vaccination

- Station
You are an FY2 in GP. Wendy presented to the clinic with her 8 weeks
old boy , Tom. She wants to know about the vaccines that can be given
to her baby. Talk to her , explain to her about the vaccines that can be
given at 8 weeks of birth and address her concerns.

- 3 vaccines are given at 8 weeks.

- It's safe for your baby to have the 6-in-1 vaccine at the same time as
other vaccines, such as the rotavirus vaccine, and MenB vaccine.

1. The 6-in-1 vaccine

 It's given as a single injection into your baby's thigh to protect your
baby against 6 serious childhood conditions

 Diphtheria
 hepatitis B
 Hib (Haemophilus influenzae type b
 Polio
 Tetanus
 whooping cough (pertussis )
 The 6-in-1 vaccine is given to babies when they're 8, 12 and 16
weeks old. They need 3 doses to make sure they develop strong
immunity to the conditions the vaccine protects against.

21
  The 6-in-1 vaccine works well And produces very good immunity
to diphtheria, tetanus, whooping cough, Hib, polio and hepatitis B
infections.

 The 6-in-1 vaccine is very safe. It's killed (inactivated), which

means it does not contain any live organisms, so there's no risk of
your baby getting the conditions from the vaccine.

- Side effects of the 6-in-1 vaccine : Common reactions include:

 pain, redness and swelling where the injection was given
 high temperature (more common after the 2nd and 3rd doses)
 being sick
 irritability
 loss of appetite
 Unusual high-pitched crying and fits or seizures are rare side
effects of the 6-in1 vaccine.
 Very rarely, a baby may have a severe allergic reaction
(anaphylaxis) after the 6-in-1 vaccine.

- Contraindications
 have a high temperature at the time of the vaccination
appointment – wait until they've recovered
 have a neurological problem that’s getting worse, including
poorly controlled epilepsy – wait until they’ve been seen by a
specialist
 There's no need to postpone vaccination if your baby has a
minor illness, such as a cough or a cold with no temperature.

2. Rotavirus vaccine

22
  An oral vaccine against rotavirus infection is given to babies as part
of their routine childhood vaccinations.

 The vaccine is given as 2 doses, 4 weeks apart. Usually the first

dose is given at 8 weeks, and the second dose at 12 weeks.

 The vaccine is given as a liquid straight into the baby's mouth for
them to swallow.

- Why the rotavirus vaccine is offered

 Rotavirus is a highly infectious stomach bug that typically affects
babies and young children, causing diarrhoea and vomiting,
tummy ache and a high temperature.

 Occasionally, treatment in hospital is needed for complications

such as severe dehydration.

- How the rotavirus vaccine works

 The vaccine contains a weakened version of rotavirus.

 This helps your baby build up immunity, so that the next time
they come into contact with rotavirus they will not get the
infection.

- Effectiveness of the rotavirus vaccine

 The rotavirus vaccine is very effective and gives good protection
against rotavirus infection.

 It’s possible for a baby to get a rotavirus infection after being

vaccinated. But this is uncommon and it’s usually milder than it
would have been if they had not been vaccinated.

23
- Safety of the rotavirus vaccine
 There's a lot of evidence showing that the rotavirus vaccine is safe.

 The brand name of the vaccine used in the UK is Rotarix. This

vaccine has been used in many countries for more than 10 years.

- Side effects of the rotavirus vaccine

 Most babies do not have any problems at all after having their
rotavirus vaccination.

 Some babies who have the vaccine may become restless and
irritable, and some may develop mild diarrhoea in the days
following vaccination.

 Very rarely, the vaccine could cause a severe allergic reaction

(anaphylaxis) or a blockage in a baby’s intestine
(intussusception).

3. MenB vaccine

 The MenB vaccine will protect your baby against infection by

meningococcal group B bacteria.

 These bacteria are responsible for about 9 in every 10

meningococcal infections in young children.

 Meningococcal infections can be very serious life-threatening,

causing meningitis and sepsis. This can lead to severe brain
damage, amputations and, sometimes, death.

- Who can have the MenB vaccine and when

24
  It's given to babies at : 8 weeks - 16 weeks - 1 year

- How the MenB vaccine is given

 It's given as a single injection into your baby's thigh.

- MenB vaccine safety

 Like all vaccines, the MenB vaccine can cause side effects, but
studies suggest they're generally mild and do not last long.

- Side effects of the MenB vaccine

 Babies given the MenB vaccine alongside their other routine
vaccinations at 8 and 16 weeks are likely to develop a high
temperature within 24 hours of vaccination.

 It's important to give your baby liquid paracetamol following

vaccination to reduce this risk and help with other symptoms.

 Other common side effects of the MenB vaccine include:

 pain, swelling or redness where the injection was given

 diarrhoea or being sick
 crying and irritability
 An allergic reaction is a rare side effect of the MenB vaccine. This
may be a rash or itching that affects part or all of the body.

 Very rarely, a baby may have a severe allergic reaction

(anaphylaxis) after having the MenB vaccine.

25
- How the MenB vaccine works
 The MenB vaccine is made from 3 major proteins found on the
surface of most meningococcal bacteria, combined with the outer
membrane of 1 MenB strain.

 Together, they stimulate the immune system to protect

against future exposures to meningococcal bacteria.

26